The detection of intraductal papillary mucinous neoplasms (IPMN), precancerous lesions of the pancreas, is rising due to the increasing use of high-resolution cross-sectional imaging. These cystic neoplasms have been shown to evolve from low-grade dysplasia to high-grade dysplasia to invasive carcinoma and are believed to account for 20-30% of all pancreatic cancers. The management of patients with some forms of IPMN remains controversial because current technologies are unable to reliably distinguish between low and high risk IPMN. There is therefore a need to develop better tools to facilitate the management of controversial lesions. The goal of this proposal is to develop and test an ultra-sensitive DEST method for profiling circulating extracellular vesicles (EV) shed by high risk IPMN. Specifically, we propose to i) develop and validate new marker sets relevant for IPMN progression at unprecedented sensitivities (aim 1) and ii) expand and rigorously test the approach for point-of-care analyses in prospectively collected clinical samples (aim 2). We hypothesize that highly sensitive EV analysis will shed valuable light on biomarker composition in IPMN, a necessary prerequisite to identify high risk lesions and early PDAC. The proposed DEST method has the potential to transform IPMN/early PDAC cancer research and clinical practice.